Any joint cavity containing synovial fluid, material, and some white blood cells. common bacterial infection of the mouth is called septic arthritis or infectious arthritis. It is considered the most dangerous type of acute arthritis. Approximately 100,000 people, in general, 2-10 suffer from this disease. In addition, over 100,000 patients with rheumatoid arthritis, 30 and 70 are affected. About half of the cases are related to the knee joint. Wrists, hips and ankles are also involved.
Symptoms of septic arthritis
sedimentation rate 50 mm / h - available for 60-80% of cases
feverish - available for 40-60% of cases
large number of white blood cells - available for 25-60% of cases
In general, a single exposure joint swelling and pain after a motion is active or passive. Those with rheumatoid arthritis, gout and systemic connective tissue are more prone to this disease. In 10-19% of patients, the disease appears as polyarticular arthritis.
Causes of septic arthritis
intravenous drug use
evidence of sexually transmitted diseases
Immunosuppressive states
Recent steroid injection
Rheumatism
The diagnosis of septic arthritis
Synovial fluid analysis should have the following parameters:
Gram Stain
Culture
leukocytes account
differential and crystal examination
When a WBC over 50,000, with a polymorphonuclear predominance seen, septic arthritis is usually inferred. Gram staining is a positive result in 11-80% of cases. Rarely, the mucin precipitate from synovial fluid may lead to a false positive. In 90% of non-gonococcal bacterial arthritis, synovial fluid culture is positive.
Differential Diagnosis
seronegative spondyloarthropathies such as psoriatic arthritis, Reiter syndrome, ankylosing spondylitis and rheumatoid diseases related to inflammatory bowel disease may occur as an acute inflamed joint
20% of untreated patients develop chronic persistent Lyme synovitis
15% of people with infective endocarditis are affected by this disease
those with common chronic diseases are at greater risk of septic arthritis as delayed diagnosis and early treatment can cause serious outbreak of foot
Treatment of septic arthritis
1 - Antibiotics
The choice of antibiotic depends on the following factors:
Patient age
suspected source of infection
View patient infection
immunosuppression such as diabetes record
suspected pathogen
Treatment is provided as follows:
First, parenteral antibiotics are used. Semisynthetic cephalosporin or penicillin is recommended. If allergic to penicillin, then clindamycin or vancomycin is prescribed
Third-generation cephalosporins are recommended for Gram-negative bacterial infections
direct inoculation of antibiotics is essential because it is more useful than parenteral antibiotics
Duration of treatment depends on patient response and organism isolated during the final culture.
2 - drain the infected attachments
needle aspiration is used for simple cases. For more complex as the shoulder, hip and sacroiliac joints, an arthrotomy is the first option. After arthrotomy, joints must be sealed. Drainage of these joints is closed suction systems. Surgery is considered for patients who do not respond to antibiotics or who have diseases such as diabetes, rheumatoid arthritis, immunosuppression, or systemic symptoms. The goal is surgical removal of nonviable tissue and purulent material needed to complete Synovectomy.
3 - prosthetic joint infection
In many cases, remove the joint prosthesis is essential. This is done by excision arthroplasty or joint movement. It is 4-6 weeks of antibiotic therapy between prosthesis removal and relocation of us. If surgical removal is not practical, then long-term antibiotic suppression is the choice.
It was found that after onset of symptoms if the patient starts treatment this week, there is a good response. If treatment is started after one month, the answer is wrong.
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